Name four ways haemostasis occurs or is achieved in surgery, and give examples of what would be used to achieve this
John North, 53, has a history of type I diabetes mellitus, cigarette smoking (40 pack years), coronary artery disease (CAD) and peripheral vascular disease (PVD). Six weeks ago, he developed a wound on his left heel that measured 4 cm by 2 cm. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a below knee amputation (BKA) of the left lower extremity tomorrow at 10 am. His meds include daily insulin, aspirin 325 mg/day and Pletal (cilostazol) 100 mg b.i.d. He has an advanced directive and no known drug allergies (NKDA).
What will be an ideal response?
Answer:
Natural haemostasis: intrinsic and extrinsic pathways
Chemical haemostasis: biological dressings, controlled hypotension, gelatin sponge (gelfoam), oxidised cellulose (oxycel, surgicel), Thrombostat (topical thrombin)
Mechanical methods: bone wax, instruments and ligation, ligating clips
Thermal methods: cryosurgery, hypothermia—localised or systemic, electrocautery, laser, hot or cold packs
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